Cor triatriatum y drenaje venoso anómalo / Cor triatriatum and unusual pulmonary venous drainage

No disponible

Fístulas arteriovenosas de los troncos supraaórticos / Arteriovenous fistulas of supra-aortic trunks

No disponible

Evolución fatal tras trombólisis de un ictus secundario a endocarditis infecciosa / Fatal outcome following thrombolysis for stroke secondary to infectious endocarditis

No disponible

Utilidad de la angiografía rotacional 3D en el diagnóstico de origen anómalo de arteria coronaria izquierda en tronco pulmonar / Use of 3D-rotational angiography in the diagnosis of the anomalous origin of the left coronary artery in the pulmonary artery

No disponible

Síndrome constitucional secundario a mixoma auricular izquierdo / Constitutional syndrome secondary to left atrial myxoma

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ECG de agosto de 2015 / ECG, August 2015

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A loud right-apical systolic murmur is associated with the diagnosis of secondary pulmonary arterial hypertension: retrospective analysis of data from 201 consecutive client-owned dogs (2006-2007).

Canine pulmonary arterial hypertension (PAH) remains under-recognized and under-treated despite being prevalent. This retrospective study investigated whether selected historical and physical examination findings were associated with the diagnosis of canine PAH, defined as tricuspid regurgitation (TR) with a confirmed systolic pressure gradient ≥ 35 mm Hg. Two hundred and one client-owned dogs (PAH group, n=96; control group, n=105) were studied. Dogs in the control group had TR with a confirmed systolic gradient <35 mm Hg. All dogs underwent a complete physical examination and a complete echocardiographic assessment. A loud systolic right-apical murmur (RAM) was significantly associated with TR ≥ 35 mm Hg. The proportion of dogs with PAH significantly increased as the RAM grade increased, with odds ratios of 4.4-37.6 for Grades 3/6-5/6 (P=0.004 to <0.001), respectively. A stronger right-than-left apical-murmur had a positive predictive value (PPV) of 83% and was 96% specific for TR ≥ 35 mm Hg, and when combined with syncope, it had a PPV of 92% and was 92% specific. A Grade ≥ 4/6 RAM had a PPV of 85% and was 93% specific. Syncope with a Grade ≥ 4/6 RAM had a PPV of 94% and was 92% specific. Ascites combined with a Grade ≥ 4 or ≥ 5/6 RAM had a PPV of 100% and was 100% specific for TR ≥ 35 mm Hg. For each of these three murmur categories (Grades ≥ 4/6, ≥ 5/6, and a louder-right-than-left murmur), when detected with no concurrent ascites or syncope, the positive likelihood ratio varied from 4.6 to 6.4. A loud systolic RAM in dogs with degenerative valve disease is highly suggestive of concurrent PAH.

Casos clínicos en Cardiología (Nº 11): lactante de tres meses que se fatiga con las tomas / Clinical cases in Cardiology (nº 11): three months old infant showing shortness of breath when feeding

Continuamos con la serie de casos clínicos en Cardiología pediátrica, revisando los motivos de consulta y datos exploratorios frecuentes en las consultas de Pediatría de Atención Primaria, y presentados de forma breve y práctica. En este número se presenta el caso de un lactante de tres meses que acude por fatiga y sudoración con las tomas. Se discute cómo la exploración y los hallazgos electrocardiográficos orientan el manejo diagnóstico de este paciente (AU)

We continue the series of clinical cases in Pediatric Cardiology checking frequent reasons for consultation in the pediatric offices of Primary Care as well as exploratory signs, and presenting them in a brief and practical way. In this paper, we present the case of a 3 month-old infant who is taken because of shortness of breath and sweating with feeding. The way the physical exploration and the electrocardiographic findings guide the diagnosis of this patient is discussed (AU)

Endocarditis por Candida sp. Experiencia en un hospital terciario y revisión de la literatura / Candida sp endocarditis. Experience in a thirdlevel hospital and review of the literature

A pesar de la relativa alta frecuencia de candidemia, la endocarditis por Candida sp es una entidad rara. Describimos cinco casos de endocarditis por Candida ingresados en nuestro hospital en el período comprendido entre los años 2005-2011. Dos de los casos estaban causados por Candida albicans, dos por Candida parapsilosis, y en otro de ellos no se identificó la especie de Candida. Todos ellos, salvo uno, presentaban claros factores de riesgo de candidemia. El tratamiento consistió en anfotericina B con/sin flucitosina en cuatro de los pacientes, y en todos ellos se realizó cirugía de sustitución valvular y/o extracción de los dispositivos intravasculares. La mortalidad global fue del 60%, y en un 40% fue directamente relacionada con la endocarditis. A todos los pacientes que sobrevivieron se les administró tratamiento supresor con fluconazol durante un mínimo de dos años, tras cuya suspensión hubo un caso de recidiva(AU)

Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report five cases of Candida endocarditis admitted to our hospital in the period between 2005 and 2011. Two cases were caused by C. albicans, two cases were caused by C. parapsilosis and in the last one, we didn´t identify the species of Candida. All but one had clear risk factors for candidemia. Treatment consisted of amphotericin B with / without flucytosine in four patients, and they all underwent surgery for valve replacement and / or removal of intravascular devices. Overall mortality was 60% (40% of mortality was directly related to endocarditis). All patients who survived were given suppressive therapy with fluconazole for a minimum of two years.After stopping fluconazole there was a case of recurrence(AU)

Casos clínicos en Cardiología (nº 9): niño con soplo sistólico y alteración electrocardiográfica / Clinical cases in Cardiology (nº. 9): 8 years old scholar with systolic murmur and ECG alteration

Continuamos con la serie de casos clínicos en Cardiología Pediátrica revisando los motivos de consulta frecuentes en las consultas de Pediatría de Atención Primaria, presentados de forma breve y práctica y tratando de mostrar la utilidad del electrocardiograma, método diagnóstico del que disponemos en Atención Primaria. En este número se presenta el caso de un niño de ocho años en el que se detecta un soplo cardiaco en una revisión rutinaria. Se discute cómo la exploración y los hallazgos electrocardiográficos orientan el manejo de este paciente (AU)

We continue the series in Paediatric Cardiology checking frequent reasons for consultation in the paediatric offices of Primary Care, presenting them in a brief and practical way and trying to show the electrocardiogram usefulness, diagnostic tool available at the Primary Care office. In this paper we present the case of an 8 years old boy with a systolic cardiac murmur detected in the well child consultation. The way clinical and electrocardiographic findings guide the diagnosis of this patient is discussed (AU)

Muerte súbita debida a miocardiopatía histiocitoide / Sudden death due to histiocytoid cardiomyopathy

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Varón de edad avanzada con soplo sistólico. Propuesta de un esquema de diagnóstico diferencial / Elderly male with systolic murmur. A proposal of a differential diagnosis schema

La presencia de un soplo sistólico a la auscultación cardiaca es un hallazgo frecuente en los pacientes de edad avanzada. El origen de estos soplos, puede ser debido a causas banales sin trascendencia clínica ni pronóstica o pueden ser provocados por patologías graves que requieren tratamiento específico. La prueba de elección para el estudio de un soplo es, en la actualidad, la ecocardiografía döppler. Sin embargo, la auscultación minuciosa junto con la realización de determinadas maniobras auscultatorias y el estudio del pulso carotideo son técnicas fundamentales en la consulta del médico de familia que nos permiten aproximarnos al diagnóstico y seleccionar a los pacientes para la realización de un estudio ecocardiográfico (AU)

The presence of a systolic murmur on cardiac auscultation is a frequent finding in the elderly patient. The origin of these murmurs may be due to insignificant causes without clinical or prognostic importance or may be caused by serious conditions that require specific treatment. The test of choice to study a murmur is currently the Doppler echocardiography. However, careful auscultation together with the performance of some auscultation maneuvers and the study of the carotid pulse are fundamental techniques in the family medical consultation that allow us to approach the diagnosis and select the patient who need an echocardiography study AU)

Hipoplasia de la porción apical del ventrículo izquierdo / Isolated left ventricular apical hypoplasia

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“El corazón más grande que la caja”: un caso de Cor Pulmonale / “The heart bigger than the box”: a case of Cor Pulmonale

El Cor Pulmonale (CP) se produce como resultado de un aumento de la presión en los pulmones, lo que origina un incremento en el tamaño del ventrículo derecho (VD) por sobrecarga. Aproximadamente un 20-30% de los ingresos hospitalarios por insuficiencia cardiaca congestiva se debe a insuficiencia ventricular derecha asociada a CP. La causa más común es la EPOC (enfermedad pulmonar obstructiva crónica). La clínica, el electrocardiograma y la radiografía de tórax son inespecíficos. El método diagnóstico no invasivo de elección es el ecocardiograma-doppler, pero el cateterismo cardiaco es la prueba gold estándar. El tratamiento se basa en diuréticos, vasodilatadores y oxígeno a largo plazo (AU)

Cor pulmonale (CP) occurs when there is increased pressure in the lungs, causing enlargement of the right ventricle (VD) due to pressure overload. Approximately 20-30% of hospital admissions for congestive heart failure are due to right ventricular failure associated with CP. The most common cause is COPD (chronic obstructive pulmonary disease). The clinical, electrocardiogram, and chest X-ray examinations are non-specific. Doppler echocardiogram is the non-invasive diagnostic method of choice is, however cardiac catheterization is the gold standard. Treatment is based on diuretics, vasodilators and long-term oxygen (AU)

Casos clínicos en Cardiología (nº 3): niño de 7 años con un soplo sistólico / No disponible

Continuamos con la serie de casos clínicos en Cardiología pediátrica revisando los motivosde consulta y datos exploratorios frecuentes en las consultas de Pediatría de Atención Primaria,y presentados de forma breve y práctica. En este número se presenta el caso de un niñode 7 años al que se le detecta un soplo sistólico en el contexto de una infección respiratoria vírica.Se discute cómo la exploración y los hallazgos electrocardiográficos orientan el manejodiagnóstico de este paciente(AU)

We continue the series of clinical cases in Pediatric Cardiology checking frequent reasonsfor consultation in the pediatric offices of Primary Care as well as exploratory signs, and presentingthem in a brief and practical way. In this paper we present the case of a 7 years old boyto whom a systolic murmur is noticed in the context of a viral respiratory infection. The waythe physical exploration and the electrocardiographic findings guide the diagnosis of this patientis discussed(AU)

An unusual cause of left ventricular outflow tract obstruction: the importance of a new systolic murmur with a large pleural effusion.

BACKGROUND: Left ventricular outflow tract obstruction due to systolic anterior motion of the mitral valve occurs as a result of a dynamic interplay between the anatomy and mechanics of the heart. While systolic anterior motion and left ventricular outflow tract obstruction are well-recognized hallmarks of hypertrophic obstructive cardiomyopathy, several other specific etiologies have been described with similar pathophysiology. CASE REPORT: We present a unique case of a middle-aged woman who developed acute dynamic left ventricular outflow tract obstruction due to systolic anterior motion of the mitral valve resulting from a large left-sided pleural effusion. CONCLUSIONS: Dynamic outflow tract obstruction should be considered among the potential causes of a new systolic murmur in patients with large pleural effusions in the absence of valvular heart disease.

Resolution of a giant atrial thrombus following anticoagulation therapy.

We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy, repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant therapy.